The Spine Journal 3 (2003) 28S–36S
1529-9430/03/$ – see front matter © 2003 Elsevier Inc. All rights reserved.
doi:10.1016/S1529-9430(02)00562-4
Spine rehabilitation: secondary and tertiary nonoperative care
Tom Mayer, MD
a,
*, Peter Polatin, MD
b
, Barry Smith, MD
c
, Robert Gatchel, MD
b
,
David Fardon, MD
d
, Stanley Herring, MD
e
, Charlotte Smith, MD
f
Ronald Donelson, MD
g
, David Wong, MD
h
North American Spine Society Committee: Contemporary Concepts Review Committee
Departments of
a
Orthopedic Surgery and
b
Psychiatry, University of Texas Southwestern Medical Center, 5701 Maple Avenue, 100, Dallas, TX 75235, USA
c
Department of Physical Medicine and Rehabilitation, Baylor University Medical Center, 411 N. Washington Avenue, 4000, Dallas, TX 75246-1713, USA
d
Knoxville Orthopedic Clinic, 1128 Weisgarber Road, Knoxville, TN 37909, USA
e
Puget Sound Sports and Spine Physicians, 1600 E. Jefferson, 401, Seattle, WA 98122-5698, USA
f
PO Box 685226, Austin, TX 78768-5226, USA
g
Department of Orthopedic Surgery, 13 Gibson Road, Hanover, NH 03755-3202, USA
h
Institute for Spinal Microsurgery, Denver Orthopedic Clinic, 1601 E. 19th Avenue, 5000, Denver, CO 80218-1216, USA
Introduction
Spine rehabilitation is the discipline of medicine that
guides physical, psychological and social recovery of peo-
ple who have become partially or totally disabled because
of spinal disease or injury. Physical recovery of people so
afflicted requires reconditioning in ways that are analogous
to the recovery of motion, strength and functional capability
after, for example, knee injuries. Because the muscles and
joints of the spine are not easily observed, the need for reha-
bilitation from spinal disorders has been recognized more
slowly than that for disorders of the extremities and the
gains from rehabilitation have been more difficult to mea-
sure by objective standards. Also, appreciation of the com-
plex interrelationship between physical, psychological and
social effects of spinal disorders is relatively new and in-
completely explored.
Spine rehabilitation has evolved rapidly over the past
two decades because of progress in standardization of
methods and terminology, flow of information, definition
of treatment guidelines and attention to outcomes and
costs. This report provides information on spine rehabili-
tation by focusing on current definitions and concepts.
It upgrades information and references provided in the
original report. That report was published in 1995 and
represented work performed by the Texas Spine Treat-
ment Guideline Task Force, along with the North Ameri-
can Spine Society Committees on Nonoperative Care and
Contemporary Concepts Review [1]. The Contemporary
Concepts Review information was to be updated every so
often, and this report represents the first revision since
1995.
We discuss methods of spine rehabilitation that have
emerged from experience with work-related disorders, be-
cause they have the greatest economic implications for soci-
ety. Specific socioeconomic outcomes, such as return to
work, are of great importance. A compensation environ-
ment ties financial benefits to medical benefits, thus compli-
cating responses to medical treatment. However, the reader
should not believe that such influences are unique to
worker’s compensation. Compensation disability that is not
directly related to work (short- and long-term disability,
personal injury–related disability, Social Security Disability
Income and so forth), often hidden from the medical pro-
vider, may produce psychosomatic behaviors detrimental to
productivity and treatment costs. Design of modern spine
rehabilitation is being driven by measures of outcome rela-
tive to costs. Such evaluations require attention to quality
of patient care, and that long-term and multifocal reduc-
tion in costs follow quality care, even though short-term or
narrowly focused evaluations may not reflect immediate
savings.
Treatments of chronic pain derive from concepts about
pain and methods of evaluating pain. Traditionally, doctors
have focused on causes of pain, assuming a physical basis
for pain that, once identified, could be eliminated or
blocked. Assessment focused on identifying the physical
basis or “pain generators.” This cause-and-effect approach
remains popular in some pain management circles, often
leading to multiple operations, injections or prolonged reli-
FDA device/drug status: Not applicable; nothing of value received
from any commercial source.
* Corresponding author. 5701 Maple Avenue, Suite 100, Dallas, TX
75235, USA. Tel.: (214) 351-6600; fax: (214) 351-6958.
E-mail address
: tmayerpestes50@aol.com (T. Mayer)